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Name of Drug: Ibestaran
Trade: Avapro
Classification: Angiotensin II Receptor Antagonists
Usual Dose: 150 mg once daily; may be increased to 300 mg once daily. Initiate therapy at 75 mg once
daily in patients who are receiving diuretics or are volume depleted. Patients with Type 2 diabetic
nephropathy--300 mg once daily.
Action: Blocks vasoconstrictor and aldosterone-producing effects of angiotensin II at receptor sites,
including vascular smooth muscle and the adrenal glands.
Therapeutic Effects:
Lowering of blood pressure.
Slowed progression of diabetic nephropathy (irbesartan and losartan only).
Reduced cardiovascular death and hospitalizations due to CHF in patients with CHF (candesartan
and valsartan only).
Decreased risk of cardiovascular death in patients with left ventricular systolic dysfunction who
are post-MI (valsartan only).
Decreased risk of stroke in patients with hypertension and left ventricular hypertrophy (effect
may be less in black patients) (losartan only).
Adverse Reactions:
CNS: dizziness, anxiety, depression, fatigue, headache, insomnia, weakness.
CV: hypotension, chest pain, edema, tachycardia.
Derm: rashes.
EENT: nasal congestion, pharyngitis, rhinitis, sinusitis.
GI: abdominal pain, diarrhea, drug-induced hepatitis, dyspepsia, nausea, vomiting.
GU: impaired renal function.
F and E: hyperkalemia.
MS: arthralgia, back pain, myalgia.
Misc: angioedemia
Drug Interactions:
Antihypertensive effect may be blunted by NSAIDs
Increased antihypertensive effects with other antihypertensives and diuretics.
Telmisartan may increase serum digoxin levels.
Concurrent use of potassium-sparing diuretics, potassium-containing salt substitutes,
angiotensin-converting enzyme inhibitors, or potassium supplements may increase the risk of
Candesartan may increase serum lithium levels.
Irbesartan and losartan may increase effects of amiodarone, fluoxetine, glimepiride, glipizide,
phenytoin, rosiglitazone, and warfarin.
Rifampin may decrease effects of losartan
Nursing Implications:
Assess blood pressure (lying, sitting, standing) and pulse periodically during therapy. Notify
health care professional of significant changes.
Monitor frequency of prescription refills to determine adherence.
Assess patient for signs of angioedema (dyspnea, facial swelling). May rarely cause angioedema.
CHF: Monitor daily weight and assess patient routinely for resolution of fluid overload
(peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention).
Laboratory Implications:
Monitor renal function and electrolyte levels periodically. Serum potassium, BUN, and serum
creatinine may be increased.
May cause higher AST, ALT, and serum bilirubin (candesartan and olmesartan only).
May cause higher uric acid, slight decrease in hemoglobin and hematocrit, neutropenia, and
thrombocytopenia. .